"They Just Poke, Poke, Poke"

by hilzoy

It's worth bearing in mind the alternative to legal abortions:

"BEREGA, Tanzania — A handwritten ledger at the hospital tells a grim story. For the month of January, 17 of the 31 minor surgical procedures here were done to repair the results of "incomplete abortions." A few may have been miscarriages, but most were botched operations by untrained, clumsy hands.

Abortion is illegal in Tanzania (except to save the mother's life or health), so women and girls turn to amateurs, who may dose them with herbs or other concoctions, pummel their bellies or insert objects vaginally. Infections, bleeding and punctures of the uterus or bowel can result, and can be fatal. Doctors treating women after these bungled attempts sometimes have no choice but to remove the uterus. (...)

Worldwide, there are 19 million unsafe abortions a year, and they kill 70,000 women (accounting for 13 percent of maternal deaths), mostly in poor countries like Tanzania where abortion is illegal, according to the World Health Organization. More than two million women a year suffer serious complications. According to Unicef, unsafe abortions cause 4 percent of deaths among pregnant women in Africa, 6 percent in Asia and 12 percent in Latin America and the Caribbean. (...)

The 120-bed hospital in Berega depends on solar panels and a generator, which is run for only a few hours a day. Short on staff members, supplies and even water, the hospital puts a lot of its scarce resources into cleaning up after failed abortions. (...)

Dr. Mdoe (...) said rumor had it that many abortions were done by a man in Gairo, a town west of Berega. In some cases, he said, the abortionist only started the procedure, knowing that doctors would have to finish the job.

Dr. Mdoe said he suspected that some of the other illegal abortionists were hospital workers with delusions of surgical skill.

"They just poke, poke, poke," he said. "And then the woman has to come here." Sometimes the doctors find fragments of sticks left inside the uterus, an invitation to sepsis."

"Poke, poke, poke." With sticks. In the uterus. With any luck, if abortion were legal here, illegal abortionists wouldn't use sticks; just rusty and unhygienic instruments of other kinds. Goody.

70,000 dead women is an awful lot. And that, not a world without abortions, is the alternative. 

Comments

[Tony P.]

Your closing point is never emphasized enough, Hilzoy. There is a big difference between OUTLAWING abortion, and ELIMINATING abortion.

The "pro-life" fanatics seem more dedicated to the former than the latter. To the extent they are motivated by religious considerations, this is perfectly understandable. The salvation of their own immortal souls does not hang on whether more or fewer little souls are gathered unto god. It depends on their own righteousness. They are not responsible for the practical consequences. Those are god's will.

--TP

[Warren Terra]

Does this horrible suffering count as a downside from the anti-abortion Christianist perspective? I mean, these women are being punished by God for their actions ... and while I'm obviously overstating this, the argument here is different only in magnitude from the case these these people make for abstinence-only education: tell them not to do the proscribed action, and don't worry if many do it anyway, in a manner that has been made less safe by their ignorance and their lack of legal, safe alternatives.

[The Fool]

I don't know that that's an argument that would convince most pro-lifers. I mean, when I was in the evangelical school I used to attend, I would continually hear about the "genocide" of 30 million babies since Roe v. Wade. I think they'd take the trade-off of more than 70,000 women a year to the government-sanctioned "murder" of hundreds of thousands or millions of "babies" a year.

[now_what]

There is also a big difference between outlawing murder and eliminating murder, but for some reason this doesn't lead me to believe that setting up private franchises entitled to murder is a good idea.

These are some incredibly weak pro-abortion arguments.

70,000 dead women is an awful lot

50,000,000 abortions a year is an awful lot, also.

[hilzoy]

now_what: this is not an argument "for abortion". It is an argument against legalizing it. I don't expect that it will convince anyone who thinks that abortion is murder. I do hope that people will bear the consequences of criminalization in mind.

[Sebastian]

But for the most part aren't we talking about late term abortions? That is what the majority of Americans want to seriously limit. That would put the numbers of abortions in question at less than 1,000 per year. Of which, I'm assured the number of necessary ones is nearly all of them. So we are talking about outlawing perhaps a dozen near infanticides a year.

[Awesom0]

@now_what

So, should we be trying all these women for murder? If you truly believe it's murder, then do you support sending them all to prison for 25 to life?

If you believe abortion is murder, then I don't see what other conclusion one can reach other than this.

[now_what]

It is an argument against legalizing it

Have you been getting enough sleep? No snark.

[Warren Terra]

now_what:

70,000 dead women is an awful lot

50,000,000 abortions a year is an awful lot, also.

My first impulse was to be flippant and to quote some other large statistics of increasing levels of irrelevance. I didn't do it, but it reflected my visceral response, which is that you act as if there is an automatic 1:1, or even 1:700, comparison to be made there. The simple fact is that there is a very real debate as to when human life begins, and you will not convince me, nor I believe will you find a convincing and complete science-based argument to convince anyone else, that it begins at conception. At the other end, the number of people who don't believe a newborn is human is vanishingly small, and the number that believe that a fetus capable of surviving a premature delivery isn't human isn't much larger. But for your comparison of 50,000,000 abortions (wherever you get that number) with 70,000 dead women (a number that would surely rise were abortions to become illegal) to be at all significant, you have to assume that those 50,000,000 abortions terminated human lives, and that is very much open to debate.

Sebastian:

So we are talking about outlawing perhaps a dozen near infanticides a year.

Are we? I didn't know we were having that debate. In any case, if we are indeed having it, my understanding was that very late-term abortions are rare, and that the number of very late-term abortions that aren't caused by major medical complications or by horrifying fetal abnormalities is so small that I haven't seen an actual concrete example - i.e., I refuse to concede that it even reaches your "perhaps a dozen" number.

Late-term abortions have always been highly regulated. In one of these threads I quoted the original Roe V Wade decision, and even in 1973 in the decision that legalized abortion it was made explicit that as the fetus approaches independent viability it gained status deserving of protection. Why you think this has been ignored and we're seeing even a dozen medical infanticides a year is quite beyond me.

[Sebastian]

"Why you think this has been ignored and we're seeing even a dozen medical infanticides a year is quite beyond me."

Because the system is set up in an extremely non-transparent way, with little outside oversight, and most of the oversight by the very people who are performing the actions in question. It would be like appealing SOLELY to the internal oversight of prison guards when wondering about whether or not they ever beat prisoners. And when people even want to look at the documents produced by the prison guards, the prison guard's union suppresses them.

It would make you untrusting of the reports that no prisoner ever gets beaten by guards.

If all of the video taped evidence of torture by the Bush administration vanished, and the bodies were disposed of, and you were left with reports from the interrogators which said "no torture here, and how dare you question my professionalism" would you trust that? Even if you thought that *most* interrogators probably didn't torture?

If policemen refused to allow their interrogations to be taped, and asked you to rely on their affidavits that there was no coercion, would you trust that, or ask for more proof?

[Warren Terra]

Sebastian, if I'm understanding you correctly, you pulled that number from you nether regions and your defense is that better numbers are hard to come by.

I will note that for all the secrecy surrounding the detention programs of the Bush administration, a lot of information has been disclosed both by former detainees and by former guards and officials. Why you think that the extremely powerful and well-resourced anti-abortion movement in this country, with an entire political party under its thumb, and with the potential help from any of the human beings involved in the provision of abortions, including patients, health workers, friends and family members any of whom might undergo an ideological conversion similar to that of Norma "Roe" McCorvey, couldn't come up with actual examples if there were some to be found remains beyond me. Are you under the impression that major medical procedures happen these days without records being generated? That the people who'd like to cite a specific example just aren't motivated enough?

[Jesurgislac]

Sebastian; So we are talking about outlawing perhaps a dozen near infanticides a year.

Actually, what you are talking about is making the government the decider in medical emergencies, because neither the woman nor the doctor can be trusted to do so. Your touching faith and trust in the government to make good medical decisions is, well... remarkable. I'm happy for you to allow your health care in emergencies to be determined by a majority vote.

Less happy for you to try and inflict that curious idea that the government decides better than the patient or the doctor, on anyone else.

[mckinneytexas]

"70,000 dead women is an awful lot. And that, not a world without abortions, is the alternative."

Actually, not. If Roe were reveresed tomorrow, the issue would be decided state-by-state. Abortion to one degree or another would remain legal throughout the US. 70,000 dead is not an alternative situation, it is the present situation in what, I infer, is largely a third world phenomena, which implies a number of additional social and cultural factors separate and apart from legality vs. illegality of abortion, not the least of which are a dearth of competent medical personnel and facilities, lack of clean water and basic hygiene, economic duress so severe it can barely be imagined and social constructs that we can never fully comprehend.

Leaving aside differences over the circumstances under which abortions should be allowed or not, some of the pro-choice rhetoric and logical devices make sense only inside the echo chamber and this is one of them. It is not even a remotely credible argument to compare Tanzania with the US.

[mckinneytexas]

"Your touching faith and trust in the government to make good medical decisions is, well... remarkable. I'm happy for you to allow your health care in emergencies to be determined by a majority vote."

I am noting this because the next time nationalized health care comes up for discussion, I want Jes to keep these words in mind.

[Phil]

If Roe were reveresed tomorrow, the issue would be decided state-by-state.

No, it wouldn't. The "pro-life" contingent in Congress would immediately introduce both Federal legislation and a Constitutional amendment banning abortion, and we'd see this same fight continue in the opposite direction for another three decades.

[Phil]

I am noting this because the next time nationalized health care comes up for discussion, I want Jes to keep these words in mind.

You do understand that even in the horrible evil socialist nazi commie UK National Health, the solutions for health care emergencies are still decided on between patients and their doctors, right?

[Jesurgislac]

McKinneyTexas: I am noting this because the next time nationalized health care comes up for discussion, I want Jes to keep these words in mind.

Why? Surely you aren't childish enough to think that medical decisions in the NHS are made by majority vote? Or are you?

in what, I infer, is largely a third world phenomena

Actually, deaths of women in illegal abortions and other maternity-related death statistics are strongly tied - quel surprise! to the phenomena of criminalizing abortion. The best example of this is Romania, a country which was not economically much different from its neighbors either before or after the fall of the Iron Curtain - but under Nicolae Ceauşescu, the pro-life dictator, abortion was illegal and persecuted, and maternal mortality and morbidity statistics were the highest in Europe - a position they fell from after Ceauşescu was overthrown and his lethal pro-life laws repealed.

[wj]

Jes, why do you use all those foreign examples? There are lots of perfectly good examples from the US in the years when abortion was illegal here.

Yes, I know that abortion was in the process of being legalized state-by-state before Roe. But there were still lots of places where it was illegal. All the bad things from abortion being illegal happened (women dying from unskilled attempts). All the economic discrimination (if you were well enough off, you could travel to where it was legal). Etc., etc.

We don't have to argue about what would happen here. We already have seen what would happen here. It was not pretty.

[Jesurgislac]

wj: Jes, why do you use all those foreign examples? There are lots of perfectly good examples from the US in the years when abortion was illegal here.

Because I've never studied the examples (I don't doubt they exist) of the higher rates of maternal mortality and morbidity in US states where legal abortion was impossible to obtain, compared to states where legal abortion was possible to get.

But I have studied the equivalent stats for Romania. I am confident that, if McKinneyTexas were to trouble himself looking up the ugly truth about illegal abortion, he would find I'm right and he's wrong: Romania was no different economically and no further behind technically than its Eastern European neighbors. What Romania had, which they did not, was a stringent pro-life system of legislation which enforced anti-choice laws on women, and sky-high maternal mortality/morbidity rates. When that legislation was repealed, after Ceauşescu fell, the maternal mortality/morbidity rates fell sharply: women lived who would have died. It wasn't any sudden economic or technical change that saved them: it was the ending of Nicolae Ceauşescu's pro-life regime.

If you want to cite American examples to McKinneyTexas, feel free! He'll still ignore you.

[mckinneytexas]

"No, it wouldn't. The "pro-life" contingent in Congress would immediately introduce both Federal legislation and a Constitutional amendment banning abortion, and we'd see this same fight continue in the opposite direction for another three decades."

They've already done the amendment. It was and always will be DOA. As for legislation, the reason why Roe will be reversed, if ever, is because it is a 10th Amendment issue, i.e. a state issue, not a federal issue. The battle would move to the states, where under the Constitution, I believe it belongs.

[Phil]

Somebody better tell your political party, then, because they still have a plank in the national platform calling for a Federal ban on abortions.

[Gary Farber]

"now_what: this is not an argument 'for abortion'. It is an argument against legalizing it."

I think you meant "illegalizing it," Hilzoy.

[What the Holy Heck]

-Sebastian-
But for the most part aren't we talking about late term abortions? That is what the majority of Americans want to seriously limit. That would put the numbers of abortions in question at less than 1,000 per year. Of which, I'm assured the number of necessary ones is nearly all of them. So we are talking about outlawing perhaps a dozen near infanticides a year.

I'm not convinced that instituting even more stringent requirements on late-term abortions is going to satisfy the hard-line (and loudest) "pro-life"rs. A whole lot of them also want contraception done away with, so I don't think you're going to see them wander off into their little corner if they win on late-term abortion. They'll just go right for 2nd trimester, then 1st, then contraception. The religious idealism that drives them will not be satisfied with anything less than complete compliance with their interpretation of biblical law.

[MR]

Since when satisfying 'the majority of Americans' equals satisfying 'the hard line pro-lifers'? And if it isn't the same, then what the Holy Heck are you talking about?

(hint: a compromise is not the solution in which everybody else submits to you)

[What the Holy Heck]

@ MR: Late-term abortions are already seriously limited, which is what the majority appears to be comfortable with. I have yet to see hard evidence that illegal late-term abortions are being performed by licensed doctors in the U.S. All I've heard is hearsay spouted by wingers, which makes the "we should make it even harder" contingent less than credible, and representative of the extremists. I'm not sure I understand the value in further legislating something that's already been legislated.

[mds]

Late-term abortions are already seriously limited, which is what the majority appears to be comfortable with.

Yes, but as Sebastian noted about the polling data I linked that showed majorities supporting it for rape, severe fetal defects, or to save the life of the mother, "only" 47% approve if the baby is healthy, but there's a non-fatal health risk for the mother. So we need to make it even harder to obtain late-term abortions for any of those reasons. (I'm having a harder and harder time coming up with charitable interpretations for this line of argumentation.)

[What the Holy Heck]

I guess I'm just seeing a disconnect between the public opinion poll numbers for these slim circumstances and actual clinical data that suggests it's really going on, particularly in numbers that would require further precedent-setting legislation.

If it's there and I'm not getting it, then my bad.

[The Crafty Trilobite]

As for legislation, the reason why Roe will be reversed, if ever, is because it is a 10th Amendment issue, i.e. a state issue, not a federal issue.

The dissenting opinions in Webster, Casey et al. weren't primarily based on the 10th Amendment. The anti-choice movement calls itself "Right to Life," which is a quote from the 14th Amendment, not the 10th. They argue endlessly about the rights of the fetus as a person, not about the rights of states.

If Roe is ever reversed, it will be under the 14th Amendment. Five Catholic Justices will in their completely impartial judgment hold that a blastocyte is a person with a right to life, or that the 14th should be read to include potential persons, and that the fetus's rights turn out in their opinion to outweigh the host's right to privacy or health.

[Trevayne]

Interesting Discussion

A modest proposal.

I was talking about this issue with a firmly pro-choice friend recently who did admit that there was one situation under which she would be happy to accept strict abortion limitations. That would be if every male in the US made a sperm deposit and got a vasectomy right after puberty. That way there would never be any unwanted children and the only abortions would be in cases where there was an obvious and unavoidable serious threat to the mothers health (ectopic pregnancy, etc) or perhaps massive birth defects (is there really a point to carrying to term an anencephalic fetus with no brain that will die shortly after birth and was arguably never alive in brain activity terms).

This would largely eliminate the threat of pregnancy from rape or incest, so those excuses would not longer be necessary, unless foreign travel was involved. At the very least, it would cut the abortion rate by the success rate of vasectomy as birth control. Wouldn't 99% fewer abortions be a good thing?

I realize that this might cause VD rates to increase, since fear of pregnancy would not scare people out of having sex. It would also be very expensive, but how much do we currently spend on unwanted pregnancies, both those carried to term and aborted. Also, we could avoid much of the spending on other forms of birth control (except condoms), including the indirect health effects of birth control pills.

So gentlemen, which is more important, actually eliminating 99% of abortions, or retaining the right to impregnate anyone you have even casual sex with?

Trevayne

P.S. The sperm deposit is probably unnecessary. It should be possible to extract viable sperm regardless of the state of the seminal vesicles if something happened to your sample.

P.P.S. This proposal would also probably eliminate paternity suits, and if one was sued successfully, you could potentially sue your doctor for malpractice.

P.P.P.S. General point. I thought this topic was mainly about late term abortions. Does anyone really believe women would choose to voluntarily undergo 6+ months of pregnancy just so they could have an abortion for fun? These are very rare procedures (roughly 1 in 1000) and all of the ones I have encountered were for tragic medical necessities (anencephalic fetus, massive cancer in fetus, mother has cancer and needed chemo will kill fetus, etc).

[Jesurgislac]

Trevayne: That would be if every male in the US made a sperm deposit and got a vasectomy right after puberty.

Plus, if this were made a requirement for entrance to the US at Customs/Immigration, it would cut the tourist trade down by at least 50%.

Illegally fertile illegal immigrants would still be a problem, though, wouldn't they?

[Trevayne]

I don't think you could justify vasectomies for tourists. Immigrants on the other hand.... This is really a proxy for complete female contraception, which needs to be the end goal, just so that women will have control over their fertility and be able to have sex with anyone they choose without any worries about pregnancy.

Since I don't think there are any 100% certain methods of contraception for women, I suggested vasectomy. Granted, it isn't 100% either, but it comes very close and has AFAIK fewer long term health risks than the equivalents for women.

I just suggested it because it clarifies the issue. If the goal is the elimination of abortions, it come pretty close. If the goal is controlling women, this doesn't really help. This would do a great deal towards making them safe, legal, and rare.
It would not try to resolve the argument, but it would try to finesse it by reducing the number of abortions to the medically necessary minimum.

As far as illegally fertile immigrants go, they would definitely be a problem. I suppose there are two options. Either just disallow the abortion as it is not a medical emergency, or allow an abortion if it can be proven that an illegal was the father. The first option would probably discourage women from having sex with immigrants. The second would probably require a national DNA database unless you can find the father.

[Jesurgislac]

I don't think you could justify vasectomies for tourists.

How so? If the objective behind this is to ensure there can be no such thing as an accidental pregnancy because the only conceptions that occur within the borders of the United States are done by artificial insemination, then no male human over the age of puberty can be allowed into the United States without a vasectomy. Period.

So, men *and boys over the age of puberty) who wished to enter the United States, would have to accept that this would entail a medical examination at the border and - if the man/boy hadn't yet had the vasectomy - the donation of a sperm sample and a vasectomy. There and then. It's an out-patient procedure, I understand.

I do think this would cut down on your tourist trade. I suppose you might offer stainless steel chastity belts, locked on the arriving male traveller, removed by a customs and immigration officer on departure, for those who didn't wish to undergo the procedure.

(You do realize that this is the plot for a satiric novel, not a serious suggestion?)

[Jesurgislac]

With regard to illegal immigrants:

If this was dark satire, there would probably be some bloody treatment of the illegally-fertile illegal immigrants, and their children.

If it were light satire, there would be jailhouse scenes with law enforcement officers trying to get the illegal immigrants to masturbate so they could get a sperm sample and prove - since they hadn't had a vasectomy - that they must be in the country illegally and could be deported.

[Gary Farber]

"I suppose you might offer stainless steel chastity belts, locked on the arriving male traveller, removed by a customs and immigration officer on departure, for those who didn't wish to undergo the procedure."

The U.S. would need to invade all other countries to force vasectomies on all boys and men capable of emitting semen.

We have to fight semen over there, or we'd have to fight semen over here.

I just pray we can avoid a war over impressing semen.

[liberal japonicus]

(You do realize that this is the plot for a satiric novel, not a serious suggestion?)

Working title: Cutting in line

[Hartmut]

Unfortunately the Roman Catholic Church (not without influence in the US) has a strict anti-vasectomy policy (although KZs are not proposed as a moral alternative any more).

[PS]

Let's go up a level. While Mexico City was still in effect, the US government funded, supported, and encouraged the establishment of post-abortion care clinics abroad. I know because i worked at one. On a policy level, when women showed up seeking an abortion (legal where I was, but when the US government offers to fund your district hospital on the stipulation that you don't provide abortions, you take the money), we had to effectively tell them to go home and try it themselves first, and then to come back when it didn't work, that is if they could make the two-day donkey ride without bleeding out. "Poke poke poke" is the African-equivalent of the coat hanger method. It's something that complied with Mexico City and thus is something the US government under Bush and the anti-abortionists encouraged. Now that the rule has been rescinded, I hope these clinics can go back to providing normal, preventive, life-saving care.

[Trevayne]

Jesurgislac said: (You do realize that this is the plot for a satiric novel, not a serious suggestion?)

Well, yes, but I was hoping for a little serious discussion. I was trying to see if any of the pro-life crowd (especially the men) were actually interested in reducing abortions, as opposed to using abortion as a club to beat women. They want to compel women to bear all pregnancies to term. Are they willing to sacrifice their ability to casually procreate to avoid abortions? I probably picked the wrong venue, oh well.

What I was trying to get at was finding a means of finessing the issue. Rather than try to reconcile two opposed view points, the idea seeks to minimize the conflict by reducing the number of abortions to the medically necessary minimum. Ideally, both sexes would have access to complete contraception. Right now, I think the available methods still have problems and vasectomies are the closest to the ideal.

By ideal, I mean that men and women have to both consciously decide that they want to have a child. Artificial insemination is an easy way to decide that now. In the future, a contraceptive implant that could be turned on and off by a physician or the owner (after a several day delay) would be preferable, but that tech doesn’t exist yet.

[Jesurgislac]

I was trying to see if any of the pro-life crowd (especially the men) were actually interested in reducing abortions, as opposed to using abortion as a club to beat women.

Given that not a single pro-life organization in the United States supports provision of/education in using contraception, and not a single pro-life organisation in the United States supports paid maternity leave with guaranteed return to work, nor free daycare for low-income working mothers, nor free health care for pregnant women/mothers or babies/children, I think that's pretty much a given. Pro-life organisations are in fact to be found very much on the side of denying contraception and opposing comprehensive sex education; pro-life politicians have a strong tendency to vote against family-friendly policies.

Individual pro-lifers may profess an interest in reducing the number of abortions, but when this comes down to practicalities - even much more practical schemes like federally-guaranteed paid maternity leave, or free provision of contraception by school nurses or clinics - they either fall silent, or join with the opponents of such schemes.

When a teacher at a Catholic school was sacked for not having an abortion before her pregnancy started to show, out of all of the pro-life organisations in the US, the only one which said very mildly that maybe this wasn't actually a good thing if the objective was to support women who chose not to have abortions, was Feminists for Life. All the others were either silent or very, very positive about sacking the little slut who'd got pregnant unmarried.

[magistra]

If there are pro-life people who really want to 'save babies' without shooting people, here are my suggestions for their social and political priorities. The US currently has 1.2 million abortions a year, so:

1) Get abortion rates down to Dutch levels (about half of US rate - 600,000 'babies' saved. (Statistics at http://www.time.com/time/nation/article/0,8599,1705604,00.html)

2) In the US 28,000 children under one year die. Get that down to Singapore levels (about 1/3 rd), 20,000 babies saved. (Statistics at http://www.webmd.com/parenting/baby/news/20081015/infant-mortality-us-ranks-29th).

3) Get infant mortality rates of the following African countries down to Kenyan infant mortality rates: Angola (70200 babies saved), Sierra Leone (29,000),Niger (49,000), Mozambique (42,000), Zambia (22,000), Nigeria (217,000), Democratic Republic of Congo (78,000), Ethiopia (97,000). Total 600,000 babies.

Raw data for this at
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html.

(Note: I chose countries which do not currently have major conflicts within them, and Kenya as a realistic comparison).

In this way, pro-lifers could successfully prevent 1.2 million deaths a year (or possibly even more if they could get African mortality rates lower). Not cheap or easy, but surely just as morally satisfying?